Skip to content
Public Health Dental Hygiene Dental (PHDHP) Survey
I. DEMOGRAPHICS
1.
Location of personal residence (zip code)
2.
Location of primary practice site (zip code)
3.
Do you currently hold a PHDHP license?
YES
NO
4.
If answered YES to Question #3, list license number and date issued:
5.
Are you eligible for PHDHP licensure?
YES
NO
NOT SURE
6.
Do you currently hold a Local Anesthesia license?
YES
NO
7.
If answered YES to Question #6, list license number and date issued:
8.
Are you currently a School Certified Dental Hygienist?
YES
NO
9.
Are you currently a Member of the ADHA?
YES
NO
Current Progress,
0 of 28 answered
